居家/社區健康保全之智慧型健康照護系統---子計畫三：運動心肺功能照護系統建置與其體適能成效分析應用

Abstract

諸多證據指引建議慢性病患需接受心臟復健計畫，事實上國內外心臟病患實際參與 此計畫之比率低於三分之一；心臟病患參與復健計畫的障礙之中，主要原因是提供復健 服務的醫療機構數目不足，患者無法就近接受專業人員監測指導下進行運動復健計畫， 這種時空上的障礙導致患者接受心臟復健計畫的比率低落。此外，冠狀動脈心臟病患者 在運動中發生心跳停止的機率為1/111996 人時，發生心肌梗塞之機率為1/292990 人時， 死亡之機率1/783972 人時，運動的危險性的確高於健康成人。因此，本計畫將建置一運 動心肺功能照護系統並做體適能成效分析應用，，透過前端無線心電訊號量測裝置，內 建專家系統，與後端遠距照護平台整合，可讓許多不方便時常至大醫院接受心臟復健訓 練的患者，能夠在接受每月一兩次門診復健訓練後，在家進行運動復健，由專業人員遠 距監督其運動量，可幫助克服接受心臟復健之時空障礙，使心臟復健能普及於更多患 者。目前各醫院心臟復健部門皆使用傳統多頻道心電圖監視器，預算經費高且有線裝置 不方便使用，因此本系統亦可應用於醫療院所的心臟復健區，提高心臟復健服務的普及 性，患者於居家運動時，亦可使用此系統內設的心跳速率及心律警示功能，能提醒使用 者適時休息或有狀況發生時迅速就醫。

Although a lot of evidence and guidelines recommended that patients have to do the cardiopulmonary rehabilitation, but in fact, the actual ratio of domestic and foreign cardiac patients entering cardiac rehabilitation program is very low, usually less than one third. One of the main hindrances of patients participating cardiac rehabilitation program is insufficient number of medical institutions that can provide rehabilitation services. Patients usually can not perform exercise program under medical professionals monitoring without having to go far. This spatial and temporal difficulty led to the low rate of patients taking cardiac rehabilitation program. Besides, while patients with coronary heart disease are doing exercise, the probability of asystole is 1/111996; the probability of myocardial infarction is 1/292990; the probability of lethality is 1/783972. The risk of patients to do exercise is higher than healthy adult. Hence, this subproject will intend to develop a cardiopulmonary exercise care system and its Applications for Effectiveness Analysis of Health-related Physical Fitness to provide an instant ECG monitoring service through the integration of front-end wireless ECG measuring devices, expert system, and back-end tele-care platform. Many patients are inconvenient to go to large hospital regularly for cardiac rehabilitation training. This project will help them to exercise at home after once or twice rehabilitation training in clinic for each month and the medical professional will supervise remotely to see how much exercise they did. For that reason the project can help to break through spatial and temporal difficulty of having cardiac rehabilitation, so that cardiac rehabilitation can be extend to more patients. In addition to this, the traditional multi-channel ECG telemetry system which is currently used in cardiac rehabilitation department of many hospital costs over a million NT dollars. Economic factors will affect motivation of small and medium hospital to purchase the system. This tele-care system utilized Bluetooth wireless transmission can be concentrated on using in the cardiac rehabilitation area of medical institutions. Since existing computers and networks can be used to build the system without having to purchase new expensive mainframe, equipment budget will be much less than one million NT dollars. Consequently, this will increase the motivation of small and medium hospitals to purchase the system and further enhance the accessibility of cardiac rehabilitation to benefit cardiac patients. If patients have this tele-care system to use while they are doing exercise at home, the built-in heart rate and cardiac rhythm warning function will remind them to take a break, even to take medical treatment. More importantly, the ECG signal can be almost immediately (real time) uploaded by network to the chest pain unit of hospital. The cardiology expert will be aware of the warning at the first moment. This is an important protection to patients’ safety of doing rehabilitation sports at home.